Reviewed by Aaron Horn, LMFT
Psychosis can be overwhelmingly disorienting and disturbing. Whether it happens to you or someone close to you, it is a life-changing event. Psychosis is the collective term for many serious mental disorders that affect the mind and compromise the person’s judgment, thought processes, emotional response, behavior, communication, and perception of reality. In severe cases, people with psychotic disorders can even struggle with reality and daily life.
If your loved one has experienced a psychotic episode, it is important to know the different forms of psychosis and to understand the underlying cause of their disconnection with reality. With a proper diagnosis, correct treatment, and family support, the person can learn ways to deal with the symptoms, even if there is another severe underlying mental health condition. Even the most severe psychotic disorders can be treated effectively.
Presentations Of Psychosis
Someone with psychosis might think of himself or herself as a renowned inventor. In their head, they have created spaceships or devices that solved a major world problem. They might also think that people are copying their ideas, and someone else is enriching themselves off them.
Another scenario might be someone who thinks she receives messages from another realm or alternate universe. She may claim the messages are from guardian angels and that she is now a popular musician with adoration from many fans. She may believe that the fans are showering her with praises. However, her fans are not okay with distant affection and have begun to stalk her in her house. This causes her to check around regularly for cameras and voice recording devices.
Psychosis is the unifying factor in both scenarios painted above – shared with an altered perception of reality. However, the forms of their psychosis are remarkably different, from the scary and isolating to the grandiose and uplifting. However, the precise presentation of psychotic disorder is not the only differentiating factor in the two cases – their psychoses are borne from different origins, and detecting the particular types of psychosis is important for their recoveries.
Different Types Of Psychosis
Psychosis does not refer to a specific mental health disorder. Instead, it is a symptom that can come from different psychological and physical conditions that cause someone to disconnect from reality. These include:
Schizophrenia is a chronic mental illness that leads to the recurrence of psychotic symptoms for up to six months or more. People with schizophrenia may experience changes in behavior, delusions, and hallucinations, which can interfere with the person’s functions. Early, non-psychotic symptoms, including lack of motivation, social withdrawal, mood, sleep disorders, and professional or academic performance challenges, often precede psychosis.
Brief Psychotic Disorder
The brief psychotic disorder is when the psychotic symptoms occur abruptly and disappear quickly, lasting less than a few weeks. This psychosis is not associated with any other mental illness or substance use and is often caused by devastating stressors such as trauma or loss of a loved one. Some women deal with brief psychotic disorder following childbirth. However, this disorder can also occur with no apparent trigger.
The schizophreniform disorder has symptoms similar to schizophrenia for about a month but does not persist for more than six months. Even if the symptoms persist, it is a sign that the person is dealing with another mental health condition.
People with schizoaffective disorder notice signs of psychosis, together with mood disorders such as depression or mania. To get a diagnosis of schizoaffective disorder, signs of schizophrenia and mood disruptions should be present concurrently. However, psychosis must also be present for at least two weeks when the person is not dealing with a major mood episode.
Bipolar disorder is essentially a mood disorder, but some people may deal with psychotic symptoms during certain mood episodes, and the symptoms usually deal with the condition of their mood. For instance, if the person is in a deep depressive episode, they may experience auditory hallucinations, making them believe that living is no longer worth the trouble. However, during manic episodes, they may suffer delusions that they have superpowers or are destined for greater things.
Depression is another mood disorder, but in severe cases of the condition, the person may experience symptoms of psychosis. This is described as depression with psychotic elements or psychotic depression.
Using some types of substances, including marijuana, cocaine, alcohol, amphetamines, and LSD, may lead to psychotic symptoms. Usually, the symptoms disappear as the drug wears off, but it may persist in some cases. Withdrawal from drugs such as hallucinogens and crack cocaine can also cause delusions, confused speech, or hallucinations.
Shared Psychotic Disorder
Also known as folie à deux, this disorder occurs when someone in a relationship has delusions, and their partner adopts it as well. For instance, if the spouse has a psychotic disorder, and one of the symptoms is believing that someone is spying on them, the partner may also start to believe that too. However, their thoughts and behaviors remain normal.
Delusions, hallucinations, and other symptoms of psychosis may occur due to another illness or condition that compromises brain functions. Such conditions include brain tumors, head injury, brain injuries, neurological disorders, autoimmune disorders, endocrine disease, and sleep disorders. They may also occur due to infectious and post-infectious syndromes like syphilis, HIV/AIDS, Lyme disease, and even the flu. The form and duration of the symptoms depend on the person and a particular condition.
Paraphrenia – the condition shares symptoms with schizophrenia, but it typically begins later in life, during old age.
People with the delusional disorder have unwavering erroneous beliefs or delusions that may continue for about a month. These false beliefs usually surround a certain theme, such as grandiosity, jealousy, persecution, and somatic delusions, but could also be a mix of different themes or have no specific theme. People with delusional disorder do not deal with hallucinations or behave strangely, and their delusions do not often disrupt normal function.
The Risk Of Developing A Psychotic Disorder
About one percent of the population deals with a form of psychotic disorder. These disorders are often present in people in their late teens to early thirties and are not gender-specific. As with many other mental health conditions, psychosis often has genetic origins. People who have close relatives with this form of the disorder are at higher risk of developing it. The belief is that the disorders are linked to the hyperactivity of neurochemicals in the brain that play a major role in normal functions. Those who suffer from brain injury during pregnancy or childhood are more likely to develop the disorder.
The Need For Accurate Diagnosis And Treatment
If you or a loved one has suffered a psychotic episode, it is crucial that they undergo a comprehensive evaluation by a professional mental health doctor as soon as possible to identify the cause of the psychosis. This is important since different types of psychosis will demand different forms of treatment. Diagnosing the underlying condition is crucial to guarantee that the person gets the required care for recovery. Generally, loved ones often play a major role in the diagnostic procedure since they can provide an objective opinion on the person’s condition. The affected person is often unable to recognize the problem due to the disorder.
In some cases, the diagnosis can happen quickly, and treatment can set the person on a fast path to recovery. However, if there is serious substance use related to the psychosis, the person may need supervised detox from the substance in a residential facility, followed by an assessment, psychological and neuropsychological tests, and observation. These steps are important to obtain an accurate diagnosis and get a proper treatment plan. There is a chance that there is an underlying disorder like bipolar disorder, depression, schizophrenia, and schizoaffective disorder, which may be too complicated to resolve on an outpatient basis. Either way, long-term residential care may create a more suitable environment for the person to recover.
In extended residential treatment settings, the affected person can get thorough assessments and be under constant supervision to ensure a clear diagnosis, allowing the medical professional to differentiate between closely-related conditions and prevent a wrong diagnosis. After getting the correct diagnosis, the patient can proceed with a comprehensive treatment plan designed to meet their specific needs using both medication and psychotherapy intervention for the symptoms.
It is necessary to note that psychosis is just one of the many symptoms present. Merely preventing psychotic episodes only does not give the respite that most people with psychotic disorders require to live healthy and productive lives. Therefore, treatment must focus on both positive and negative symptoms, including behavior, thoughts, and mood aspects, which helps the patient learn the skills required to boost functionality and handle the trauma caused by the psychosis. By undergoing a comprehensive treatment plan that is flexible with their evolving needs, they can manage symptoms and build the life they desire.
The diagnostic process: if the symptoms of psychosis occur in someone, the doctor will perform a physical examination and get their medical history. After ruling out physical factors that may contribute to the strange behaviors, the doctor will refer the person to a mental health specialist with the specific tools, training, and experience to make an accurate diagnosis.
Treatment For Psychosis
The two major treatment options for psychotic disorders are medications and psychotherapy. The major medications commonly prescribed for psychosis treatment are antipsychotics. These medications help to manage symptoms of the condition like delusions and hallucinations. Examples of antipsychotics include haloperidol, pimozide, chlorpromazine, and amisulpride. Based on the effect of the medication on the person, it may be necessary for the doctor to prescribe more than one drug successively until the right medication is identified – one that gives the desired results.
Psychotherapy for psychotic disorders may include individual therapy, family therapy, and support groups. Although most patients are treated on an outpatient basis, in severe cases, like when the person's physical health is threatened, hospitalization may be required to stabilize the patient.
Aside from medication and psychotherapy, self-help can also help patients live with psychosis successfully. It is crucial that the person learns ways to cope when they experience psychotic episodes and how to get help for people with psychosis. Researching and learning everything you can about the particular disorder is important to live a happy, healthy, and satisfying life.
Outlook For Those Living With Psychotic Disorders
Many people who have received a diagnosis of psychotic disorder often go on to live productively and function normally with the right treatment. The prognosis for patients with psychotic disorders is relative. Some people may show significant improvements within a short period, while some may need weeks or months to get relief from symptoms. For instance, women are more likely to respond well to medications than men. People with a family history of the condition have a lower prognosis than others. Individual prognosis also depends on the number of negative symptoms and age. The older the patient, the better the prognosis.
The patient’s support system is also a major determinant of prognosis. Most people never recover completely from a psychotic disorder and will require treatment throughout their lives. Like those who have experienced multiple severe episodes, some people may need to use medications as long as possible. In such cases, the medication is provided in low doses to reduce side effects. To ensure physical and mental stability with the disorder, the patient needs to follow the treatment recommended by the healthcare professional.
Psychosis does not affect the patient alone – it also affects the people around them. Therefore, every member of the family requires support to deal with the impact of the condition on their lives. By participating in the treatment process of the affected person and family therapy, they can better understand themselves and their loved ones, thus breaking through the barriers of isolation and improving your bond. In therapy, one can learn crucial skills to support the patient during and after the treatment. Take an assessment test for psychosis here.